title: The iScore predicts clinical response to tissue plasminogen activator in Korean stroke patients.
abstract: BACKGROUND
  Despite substantial differences in clinical features between Asian and Western stroke patients, there are no published prognostic tools validated in an Asiatic population for thrombolytic therapy. We assessed the ability of the iScore to predict the clinical response after intravenous thrombolysis with tissue plasminogen activator (tPA) in a Korean stroke population.
  
  
  METHODS
  We applied the iScore to eligible participants in the nationwide multicenter stroke registry in Korea. Main outcome measures were poor functional outcome defined as having a modified Rankin Scale score 3-6 and death at 3 months. Symptomatic intracranial hemorrhage (sICH) was evaluated as a safety outcome. C statistic was calculated to assess performance of iScore.
  
  
  RESULTS
  Among 4760 patients with an acute ischemic stroke, 622 (13.1%) received tPA, 548 patients had complete information for the analysis. C statistics for poor functional outcome and death at 3 months were .813 (95% confidence interval [CI]: .778-.848) and .820 (95% CI: .769-.872), respectively. Overall, there was a high correlation between observed and expected outcome for poor functional outcome (Pearson correlation coefficient, r = .982) and for death at 3 months (r = .950) at the risk score level. An iScore of 180 or more was associated with a more than 2 times risk of poor functional outcome and about 6 times risk of death at 3 months. There was an interaction between the iScore and tPA for a poor functional outcome (P value for the interaction < .001). We found a gradient effect in the incident risk of sICH with the iScore.
  
  
  CONCLUSIONS
  The iScore reliably predicts stroke outcomes after tPA in Asiatic population.
authors.affiliation: Department of Neurology, Seoul Medical Center, Seoul, Korea.
authors.forename: Tai Hwan
authors.initials: TH
authors.lastname: Park
authors.affiliation: Department of Neurology, Seoul Medical Center, Seoul, Korea.
authors.forename: Sang-Soon
authors.initials: SS
authors.lastname: Park
authors.affiliation: Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.
authors.forename: Youngchai
authors.initials: Y
authors.lastname: Ko
authors.affiliation: Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea.
authors.forename: Soo Joo
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea.
authors.forename: Kyung Bok
authors.initials: KB
authors.lastname: Lee
authors.affiliation: Department of Neurology, Yeungnam University Hospital, Daegu, Korea.
authors.forename: Jun
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea.
authors.forename: Kyusik
authors.initials: K
authors.lastname: Kang
authors.affiliation: Department of Neurology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea.
authors.forename: Jong-Moo
authors.initials: JM
authors.lastname: Park
authors.affiliation: Department of Neurology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea.
authors.forename: Jay Chol
authors.initials: JC
authors.lastname: Choi
authors.affiliation: Department of Neurology, Dongguk University Ilsan Hospital, Ilsan, Korea.
authors.forename: Dong-Eog
authors.initials: DE
authors.lastname: Kim
authors.affiliation: Department of Neurology, Ilsan Paik Hospital, Inje University, Ilsan, Korea.
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Cho
authors.affiliation: Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Keun-Sik
authors.initials: KS
authors.lastname: Hong
authors.affiliation: Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Joon-Tae
authors.initials: JT
authors.lastname: Kim
authors.affiliation: Department of Neurology, Dong-A University Hospital, Pusan, Korea.
authors.forename: Dae-Hyun
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Neurology, Dong-A University Hospital, Pusan, Korea.
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Cha
authors.affiliation: Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Moon-Ku
authors.initials: MK
authors.lastname: Han
authors.affiliation: Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
authors.forename: Ji Sung
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
authors.forename: Juneyoung
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Kyung-Ho
authors.initials: KH
authors.lastname: Yu
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Lee
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Byung-Woo
authors.initials: BW
authors.lastname: Yoon
authors.affiliation: Department of Neurology, Stroke Center, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Hee-Joon
authors.initials: HJ
authors.lastname: Bae
authors.affiliation: Stroke Outcomes Research Centre, Division of Neurology, Department of Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: saposnikg@smh.ca.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality; D003661:Decision Support Techniques; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000208:ethnology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology / Q000401:mortality; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Risk score; ischemic stroke; prediction; thrombolysis